针刺治疗偏头痛急性期文献质量评价

目的对针刺治疗偏头痛急性期的临床随机对照试验研究进行文献质量评价。方法以针刺、偏头痛为检索词,检索了Cochrane图书馆临床对照试验数据库,PubMed、MEDLINE、EMbase等外文数据库和CBM、CMCC、CNKI、VIP等中文数据库。对纳入研究的报告质量,包括研究设计的方法学质量、诊断与纳入/排除标准、针刺/对照组干预措施、疗效评价标准及观察时间点、不良反应报告等方面进行评价。结果共纳入23篇随机对照试验,2 645例患者,Jadad评分仅3篇属高质量研究(≥4分)。文献质量评价结果显示,目前国内外关于针刺治疗偏头痛急性期的高质量临床研究报道较少,国际公认的诊断标准及通用的评价方法尚未得到普遍应用,对照设置欠合理。结论从目前的临床报道来看,针刺治疗偏头痛急性期有一定疗效,但仍需相关证据支持。今后国内研究应严格遵循国际公认的偏头痛诊断与疗效评价标准,设置恰当的对照方法,进行高质量的研究。     

针灸治疗脊髓损伤后神经源性膀胱研究进展

文章总结归纳针灸治疗脊髓损伤(SCI)后神经源性膀胱(NB)的国内外研究现状,主要从针灸治疗SCI后NB的作用机制、针灸方法应用、取穴特点、治疗时机、结局指标选择等方面进行阐述。针灸可促进SCI后NB患者神经干细胞增殖从而刺激神经再生,改善受损神经系统功能;可以有效诱导神经营养因子的表达,促进SCI后组织的修复;可以降低SCI后促炎和促细胞凋亡因子的表达,从而抑制神经细胞凋亡,保护神经细胞。针灸治疗SCI后NB的常用治疗方法主要包括针刺、艾灸、穴位注射及综合疗法。针灸治疗SCI后NB取穴多遵循循经取穴和局部取穴相结合的原则,关于治疗时间窗的选择尚无统一认识。多数研究认为在脊髓损伤后,排尿系统暂时失去了中枢系统的控制,但未完全受损时,早期予以针灸治疗,使该区域保持一定的感觉冲动刺激,可为后期重建反射性排尿提供良好的基础。针灸治疗SCI后NB的主要结局指标应是评价治疗前后排尿功能的差异,主要包括24 h平均排尿次数、漏尿次数、排尿量及尿失禁次数、间歇导尿次数及标准化尿垫测试等;次要结局指标包括尿动力学、生活质量、治疗有效率、安全结局指标等。但其临床疗效评价的科学性仍存在一定争议,主要体现在循证证据不强;未严格开展随机对照试验;研究对象基线不平衡;评价工具缺乏特异性;临床试验注册程序不规范等方面。在下一步研究中还需开展多中心、大样本、严格的随机对照试验,完善临床试验注册程序,科学合理地根据SCI后NB患者分型选择适宜的针灸治疗方案,并探索科学、客观的结局评价指标,以提高相关研究的科学性和可信度。     

针刺对无先兆偏头痛病人热痛阈作用的临床研究

目的:结合耐热痛阈检测评估针刺治疗无先兆偏头痛的临床疗效。方法:本研究采用随机对照临床试验设计,将35例无先兆偏头痛病人随机分为治疗组18例和对照组17例,其中治疗组接受临床有效的常规针刺治疗,对照组接受非经非穴的假穴进行对照针刺治疗。2组治疗前后分别进行耐热痛阈的检测以及头痛日记的记录,比较2组间针刺治疗后的头痛天数以及前额耐热痛阈的变化情况。结果:治疗组治疗后偏头痛发作天数较治疗前降低(P <0.05),对照组治疗后偏头痛发作天数较治疗前差异无统计学意义(P> 0.05)。治疗组和对照组进行耐热痛阈治疗前后的比较,认为治疗后治疗组的耐热痛阈显著高于对照组(P <0.01)。结论:针刺可以升高无先兆偏头痛病人的前额耐热痛阈。     

针刺治疗膝骨性关节炎的临床试验结果与对照组设置相关性研究的系统分析

为了评估针刺治疗膝骨性关节炎(Knee Osteoarthritis,KOA)的临床试验结果是否与试验对照组的设置方式相关,本次系统分析共检索7个数据库,纳入21篇2004~2014年间SCI杂志出版的针刺治疗膝骨性关节炎的随机对照试验(RCTs)文献,对等待组(Wait-list control,WL)、非刺入性假针刺组(Non-insertion sham acupuncture control,NP)和刺入性假针刺组(Needle-insertion sham acupuncture control,SN)等三种不同对照组设置方式的试验结果进行统计,结果显示三种对照组设置方式的试验结果阳性率依次为92%(WL),67%(NP)和50%(SN),充分说明针刺治疗膝骨性关节炎的临床试验结果与试验对照组的设置方式密切相关。假针刺组(尤其是刺入性假针刺组)的试验结果阳性率较低的原因可能是由针刺部位的差异、刺激方式的差异(如不同的电针参数)等针刺的特异性因素引起,也可能与非特异性的弥散性伤害抑制控制作用(Diffuse noxious inhibitory control,DNIC)产生和正常针刺相似的生理效应有关。在未来的研究中,对照组设置方式的选择仍需根据试验目的的不同进行更多深入探讨,这对针刺临床试验模式的建立尤为重要。     

针刺治疗偏头痛的临床疗效及生化机制

背景中医治疗偏头痛方法较多,其中针刺治疗偏头痛的疗效显著,往往收到针到痛止之奇效,故值得进一步研究.目的明确针刺治疗偏头痛的临床疗效,并探讨针刺治疗偏头痛的生化学机制.设计以诊断为依据的病例对照研究.地点、对象和干预将63例偏头痛患者按随机抽签法分为针刺组(32例)和对照组(31例),观察临床疗效及治疗前后血中血小板活化因子(platelet activatingfactor,PAF),血栓烷B2,6-酮-PGF1α含量,并选择20例健康人作为正常对照组.主要观察指标针刺对偏头痛症状的作用和对其血中PAF,血栓烷B2,6-酮-前列腺素F1α含量的影响.结果针刺治疗对偏头痛疗效明显,总有效率达90.6%,优于对照组(x2=3.9459,P＜0.05);偏头痛患者在治疗前血中PAF、血栓烷B2、6-酮-前列腺素F1α含量均高于正常对照组(t=6.416～13.144,P＜0.01),而针刺组在治疗后血中PAF、血栓烷B2、6-酮-前列腺素F1α含量[(18.13±1.90)μg/L,(99.65±36.43),(20.71±4.65)ng/L]低于对照组[(22.41±2.44)μg/L,(130.56±49.74),(29.67±6.78)ng/L](t=2.807～7.752,P＜0.01).结论针刺治疗偏头痛疗效明显;PAF、血栓烷B2、6-酮-前列腺素F1α均参与偏头痛的病理过程,针刺对偏头痛患者血中PAF、血栓烷B2、6-酮-前列腺素F,α有调节作用.     

星状神经节触激术联合针刺治疗偏头痛的临床效果观察

目的:探讨星状神经节触激术联合针刺治疗偏头痛的临床效果。方法:选取2016年1月至2019年1月在本院就诊的64例偏头痛患者,随机分为两组。对照组采取星状神经节触激术,观察组采取星状神经节触激术联合针刺。对比两组临床疗效。结果:观察组的有效率明显高于对照组(P<0.05);治疗后,两组的偏头痛持续时间、中医症状积分和偏头痛发作频率明显降低(P<0.05),观察组的偏头痛持续时间、中医症状积分和偏头痛发作频率明显低于对照组(P<0.05)。结论:星状神经节触激术联合针刺对偏头痛具有比较满意的治疗效果。     

针刺预防性治疗偏头痛的文献质量评价

目的对针刺预防性治疗偏头痛的随机对照研究进行文献质量评价。方法以针刺、偏头痛和预防为检索词，检索Cochrane图书馆（2007年第4期），MEDLINE（1966～2007），EMbase（1966～2007）等英文数据库和CBM（1978～2007），CMCC（1994～2007），CNKI（1994～2007）等中文数据库。手工检索《中国针灸》（1981～2007）等中医杂志及有关学术会议论文汇编。对纳入文献的方法学、诊断及纳入／排除标准、针刺／对照组干预措施、疗效评价标准及随访等方面进行评价。结果共纳入12篇随机对照研究，其中9篇高质量研究均为国外研究，3篇国内研究为低质量研究，国外研究多采用偏头痛每月发作频率、天数及SF-36／SF-12等量表作为疗效评价标准，国内则采用头痛指数计分作为疗效评价标准。9篇研究有随访记录，8篇研究报告了不良反应。结论目前国内尚无高质量的针刺预防性治疗偏头痛的临床研究报告，迄今所发表研究采用的疗效评价方法不能恰当评价针刺预防性治疗偏头痛的疗效。从试验设计及实施角度，今后应多借鉴国外同类研究的长处；从临床角度，针灸医师应认清偏头痛缓解期预防性治疗及急性期镇痛治疗的目的和意义的不同，设计出更科学的针刺预防性治疗偏头痛的试验方案。     

针刺对偏头痛大鼠脑内降钙素基因相关肽基因表达的影响

目的探讨偏头痛大鼠脑内降钙素基因相关肽(CGRP)的表达强度及针刺对CGRP基因表达的调控机制及针刺防治偏头痛的作用机制。方法参照Knyihar-Csillik方法复制大鼠偏头痛模型,将动物随机分成正常对照组、模型对照组、针刺预防组和针刺治疗组,每组10只,采用放射免疫分析法测定CGRP浓度;采用RT-PCR法测定CGRPmRNA表达。结果颈静脉血CGRP含量:正常大鼠保持低水平恒定量,模型对照组大鼠CGRP含量显著升高(P<0.01),针刺预防组及针刺治疗组与正常大鼠相近,但与模型对照组比较,显著降低(P<0.01);脑干及三叉神经节CGRPmRNA的表达变化:正常对照组表达在较低水平,模型对照组表达显著增强(P<0.01),针刺治疗组及针刺预防组与模型对照组比较,表达显著减弱(P<0.01)。结论实验性偏头痛大鼠脑内CGRP的过度表达,可能是偏头痛发作的分子机制之一;针刺调控CGRPmRNA表达可能是针刺防治偏头痛的机制之一。     

经颅超声多普勒观察针刺治疗前后血管性头痛患者脑血流变化

目的观察针刺对偏头痛患者在颅内血液动力学及脑血管调节方面的良性调节作用,以证实针刺方法是治疗偏头痛较好的方法。方法选择2003-12/2005-08天津中医学院第一附属医院针灸部收治偏头痛患者25例,以“疏通少阳,升清降浊,通经止痛”为治疗原则,针刺为治疗手段,取主穴:人迎,风池(双侧),局部配穴向对侧颔厌透率谷、太阳、禾髎。施捻转泻/补法,1次/d,14d为1个疗程,连续进行2个疗程,疗程间休息2d。治疗前后经颅超声多普勒诊断仪检查标准级别变化、血流异常、双侧血流对称情况。结果25例患者均完成全部治疗,进入结果分析。针刺后经颅超声多普勒诊断仪检查标准级别正常者多于针刺前;血流异常情况(包括血流增快,血流减慢,血管紧张增高)均比针刺前有改善;血流正常血管支数比针刺前增多;双侧血流不对称血管数少于针刺前。结论针刺可能是通过改善脑血流情况,改变脑组织血供需求,调节血流不对称性,良性调整脑血管的舒缩功能以达到缓解偏头痛症状的作用。     

丝竹空透率谷治疗偏头痛疗效观察

目的:观察采用丝竹空透率谷为主治疗偏头痛的临床疗效。方法:将60例偏头痛患者随机分为针刺组和对照组各30例。针刺组采用丝竹空透率谷,选配外关和风池穴,手法采用泻法;对照组采用口服西比灵。疗程2周,停止治疗1个月后观察疗效。结果:针刺组有效率为90.0%,对照组为56.7%。经统计学分析,针刺组疗效好于对照组,2组有效率比较有显著性差异(P<0.01)。结论:丝竹空透率谷对于偏头痛有较好疗效,具有较好的临床实用价值。     

The reporting of clinical acupuncture research: what do clinicians need to know?

It is presently unknown what the real impact of clinical acupuncture research on practitioners is, or what kind of specific information clinicians need to find on a published paper in this field. OBJECTIVES: To develop a pilot survey instrument to evaluate clinicians' information needs when reading acupuncture research papers, and then to use it to assess the relative importance that specific clinical details may have for clinicians when reading papers on the areas of acupuncture treatment for migraine/headaches and nausea/vomiting. METHODS: The survey instrument consisted of a list of 50 clinical details grouped in four areas: practitioners, patients, diagnostic procedures, and acupuncture treatment. Questions about the relative importance of these details regarding acupuncture research in general, and on the areas of migraine/headaches and nausea/vomiting in particular, were answered by 34 medical acupuncture practitioners attending a conference. RESULTS: Most clinical details were deemed important, with the highest rating for details concerning the acupuncture treatment (M = 3.25 +/- 0.43 on a scale from 0 = not at all important to 4 = very important), and diagnostic procedures (M = 2.91 +/- 0.33). Similar results applied to the research on migraine/headaches and nausea/vomiting. CONCLUSION: For acupuncture clinical research to have a real impact in daily practice, researchers need to be sensitive to the needs of clinicians and provide enough information about clinical details on the published papers. A survey instrument like this seems to be an appropriate tool to gather information about clinicians' needs.     

重复经颅磁刺激联合针刺治疗脊髓损伤后神经病理性疼痛的临床研究

目的：观察重复经颅磁刺激（rTMS）联合针刺治疗脊髓损伤（SCI）后神经病理性疼痛（NP）的临床疗效。方法：按随机数字表法将99例SCI后NP患者分成对照组、针刺组和联合组,各33例。对照组进行常规基础治疗,针刺组在对照组基础上进行针刺治疗,联合组在针刺组基础上进行rTMS治疗。分别于治疗前及治疗6周后对3组患者进行视觉模拟量表（VAS）、汉密顿抑郁量表（HAMD）、汉密顿焦虑量表(HAMA)及生活质量SF-36量表评估。结果：治疗6周后,3组患者VAS、HAMD和HAMA评分较治疗前均明显降低（P＜0.05）,SF-36量表各项评分较治疗前均明显升高（P＜0.05）;针刺组VAS、HAMD和HAMA评分较对照组均有降低（P＜0.05）,SF-36量表各项评分较对照组均有升高（P＜0.05）;联合组VAS、HAMD和HAMA评分较针刺组和对照组均有降低（P＜0.05）,SF-36量表各项评分较针刺组和对照组均有升高（P＜0.05）。结论：rTMS联合针刺治疗SCI后NP患者,有助于改善患者临床疼痛现象,且在改善患者情绪和生活质量方面疗效显著。     

Acupuncture in migraine prevention: a randomized sham controlled study with 6-months posttreatment follow-up

OBJECTIVE: To assess the efficacy of acupuncture in migraine prophylaxis. METHODS: Thirty-seven patients with migraine were enrolled in a randomized control trial at the Headache clinic located in a University Hospital. Real and sham acupuncture groups received 16 acupuncture sessions over 3 months. Treatment was individualized in the real acupuncture group and minimal acupuncture was used in the sham group. The primary end point was the percentage of patients with a >or=50% reduction in their migraine attack frequency in the second, third, fourth, fifth, and sixth (months) compared with the first one (baseline period). Primary and secondary end points were measured comparing headache diaries. RESULTS: Real acupuncture group showed improvement with significant differences compared with the sham acupuncture group in the primary efficacy end point (P=0.021) at the second month of the treatment. Differences also appeared in 2 secondary end points: number of days with migraine per month (P=0.007) in the second month and the percentage of patients with >or=40% reduction in migraine attack frequency in the first (P=0.044) and second months (P=0.004) of the treatment. These differences disappeared in the third (last) month of the treatment as a consequence of the high improvement of the sham acupuncture group. Comparisons within each group showed that several migraine parameters evaluated improved significantly in both groups. CONCLUSIONS: Individualized treatment based on traditional Chinese medicine plays a role in preventing migraine attacks. Nevertheless, sham acupuncture had similar effects. Major conclusions were limited by the small sample sizes however the observed trends may contribute to design future trials.     

Effectiveness and tolerability of acupuncture compared with metoprolol in migraine prophylaxis

OBJECTIVES: In a randomized controlled multicenter trial extending over 24 weeks, we investigated whether acupuncture is as effective and safe as metoprolol in the prophylactic treatment of migraine under conditions similar to routine care. METHODS: One hundred fourteen migraine patients could be randomized to treatment over 12 weeks either with acupuncture (8 to 15 sessions) or metoprolol (100 to 200 mg daily). Main outcome measure was the difference in the number of migraine days between baseline and the weeks 9 to 12 after randomization (derived from a headache diary). RESULTS: Two of 59 patients randomized to acupuncture withdrew prematurely from the study compared to 18 of 55 randomized to metoprolol. The number of migraine days decreased by 2.5 +/- 2.9 days (baseline 5.8 +/- 2.5 days) in the acupuncture group compared to 2.2 +/- 2.7 days (baseline 5.8 +/- 2.9 days) in the metoprolol group (P= .721). The proportion of responders (reduction of migraine attacks by > or =50%) was 61% for acupuncture and 49% for metoprolol. Both physicians and patients reported fewer adverse effects in the acupuncture group. CONCLUSIONS: Due to missing the recruitment target (480 patients) and the high drop-out in the metoprolol group the results must be interpreted with caution. Still, they suggest that acupuncture might be an effective and safe treatment option for patients unwilling or unable to use drug prophylaxis.     

Traditional acupuncture in migraine: a controlled, randomized study

OBJECTIVE: To check the effectiveness of a true acupuncture treatment according to traditional Chinese medicine (TCM) in migraine without aura, comparing it to a standard mock acupuncture protocol, an accurate mock acupuncture healing ritual, and untreated controls. BACKGROUND: Migraine prevalence is high and affects a relevant rate of adults in the productive phase of their life. Acupuncture has been increasingly advocated and used in Western countries for migraine treatment, but the evidence of its effectiveness still remains weak. A large variability of treatments is present in published studies and no acupoint selection according to TCM has been investigated so far; therefore, the low level of evidence of acupuncture effectiveness might partly depend on inappropriate treatment. DESIGN AND METHODS: A prospective, randomized, controlled study was performed in 160 patients suffering from migraine without aura, assessed according to the ICD-10 classification. The patients were divided into the following 4 groups: (1) group TA, treated with true acupuncture (according to TCM) plus Rizatriptan; (2) group RMA, treated with ritualized mock acupuncture plus Rizatriptan; (3) group SMA, treated with standard mock acupuncture plus Rizatriptan; (4) group R, without prophylactic treatment with relief therapy only (Rizatriptan). The MIDAS Questionnaire was administered before treatment (T0), at 3 (T1) and 6 months (T2) from the beginning of treatment, and the MIDAS Index (MI) was calculated. Rizatriptan intake was also checked in all groups of patients at T0, T1, and T2. Group TA and RMA were evaluated according to TCM as well; then, the former was submitted to true acupuncture and the latter to mock acupuncture treatment resembling the same as TA. The statistical analysis was conducted with factorial ANOVA and multiple tests with a Bonferroni adjustment. RESULTS: A total of 127 patients completed the study (33 dropouts): 32 belonged to group TA, 30 to group RMA, 31 to group SMA, and 34 to group R. Before treatment the MI (T(0)) was moderate to severe with no significant intergroup differences. All groups underwent a decrease of MI at T(1) and T(2), with a significant group difference at both T(1) and T(2) compared to T(0) (P < .0001). Only TA provided a significant improvement at both T(1) and T(2) compared to R (P < .0001). RMA underwent a transient improvement of MI at T(1). The Rizatriptan intake paralleled the MI in all groups. CONCLUSIONS: TA was the only treatment able to provide a steady outcome improvement in comparison to the use of only Rizatriptan, while RMA showed a transient placebo effect at T1.     

Acupuncture in migraine: investigation of autonomic effects

OBJECTIVE: A dysregulation of the autonomic nervous system is discussed as a pathogenetic factor in migraine. As acupuncture has been shown to exhibit considerable autonomic effects, we tested whether the clinical effects of acupuncture in migraine prophylaxis are mediated by changes of the autonomic regulation. METHODS: We simultaneously monitored changes of heart-rate variability (HRV) as an index of cardiac autonomic control and clinical improvement during an acupuncture treatment in 30 migraineurs. HRV was derived from spectral analysis of the electrocardiogram, which was performed before, during, and after the first and the last session of a series of 12 acupuncture sessions. Migraineurs were randomly allocated to 2 groups receiving either verum acupuncture (VA) or sham acupuncture (SA) treatment. RESULTS: Across the combined VA and SA groups, the clinical responders (with at least 50% reduction of migraine attacks) exhibited a decrease of the low-frequency (LF) power of HRV in the course of the treatment, which was not be observed in patients without clinical benefit. VA compared with SA induced a stronger decrease of high-frequency power. The mode of acupuncture, however, did not have an impact on the LF component of HRV or the clinical outcome. DISCUSSION: The data indicate, that VA and SA acupuncture might have a beneficial influence on the autonomic nervous system in migraineurs with a reduction of the LF power of HRV related to the clinical effect. This might be due to a reduction of sympathetic nerve activity. VA and SA induce different effects on the high-frequency component of HRV, which seem, however, not to be relevant for the clinical outcome in migraine.     

Efficacy of acupuncture for migraine prophylaxis: a single-blinded, double-dummy, randomized controlled trial

Insufficient clinical trial data were available to prove the efficacy of acupuncture for migraine prophylaxis. A multicenter, double-dummy, single-blinded, randomized controlled clinical trial was conducted at the outpatient departments of acupuncture at 5 hospitals in China to evaluate the effectiveness of acupuncture. A total of 140 patients with migraine without aura were recruited and assigned randomly to 2 different groups: the acupuncture group treated with verum acupuncture plus placebo and the control group treated with sham acupuncture plus flunarizine. Treated by acupuncture 3 times per week and drugs every night, patients from both groups were evaluated at week 0 (baseline), week 4, and week 16. The primary outcome was measured by the proportion of responders (defined as the proportion of patients with a reduction of migraine days by at least 50%). The secondary outcome measures included the number of migraine days, visual analogue scale (VAS, 0 to 10 cm) for pain, as well as the physical and mental component summary scores of the 36-item short-form health survey (SF-36). The patients in the acupuncture group had better responder rates and fewer migraine days compared with the control group (P < .05), whereas there were no significant differences between the 2 groups in VAS scores and SF-36 physical and mental component summary scores (P > .05). The results suggested that acupuncture was more effective than flunarizine in decreasing days of migraine attacks, whereas no significantly differences were found between acupuncture and flunarizine in reduction of pain intensity and improvement of the quality of life.     

Acupuncture in headache therapy

Acupuncture is now being increasingly used in the treatment of headache. Acupuncture is a technique originating in Asia, from countries that have a cultural background with a fundamentally different concept of disease and therapy. Up to now, sustained application of acupuncture in Western medicine has been impeded by the lack of a scientifically convincing explanation of the mechanisms of action in terms of neurobiological criteria. Acupuncture is being used empirically in the treatment of migraine; clinical studies have been published. A definitive evaluation of acupuncture based on well-founded clinical experimental studies has yet to be made. The investigation was carried out in migraine patients who were divided into two subgroups in a control group design with two different stimulation techniques. The verum group was treated with the correct point location, normal prick depth and elicitation of a needle sensation. The control group received treatment at points that are far away from the acupuncture points, using a superficial prick technique and without eliciting a needle sensation. The effect of therapy was appraised by means of headache diaries with subsequent interference statistical and individual case analysis. In the present study comprising 81 patients, the incidence of the attacks was significantly reduced in both subgroups. The effect of acupuncture treatment was of comparable magnitude to that of the beta-blocker metoprolol. The advantage of acupuncture treatment consists in the lack of side effects such as gastrointestinal symptoms or an increase in weight. A minor side effect was only reported in one case. In the data analysis with the interference statistical method, verum acupuncture was superior to the control in only one subgroup. The possibility that the addition of further points (distant points) can explain this effect on the basis of the hypothesis of a central modulation of the migraine process is discussed. Acupuncture shows a sufficiently pronounced and sustained therapeutic effect for its use to be considered in a possible interval treatment of migraine.